HomeMy WebLinkAboutSDP200800089 Application 2008-05-28County of,- nbemarle
Planning Application 1Fkt.ttk
C unity Development Department, Zoning &
Current Development Division
401 McIntire Road Charlottesville, VA 22902 -4596
Voice : (434) 296 -5832 Fax : (434) 972 -4126
TMP , 07800 - 00-00- 03110 Owner(s): MJH FOUNDATION ATTN: OFFICE OF THE PRESIDENT
Application # SDP200800089 i
Legal Description (ACREAGE
Magisterial Dist. IRivanna
8
Land Use PrimarylOffice
Applicant
Name Martha Jefferson Health Services Corporation Phone # (434) 982 -7303
Street Address 459 Locust Ave Fax # (434) 982 -7324
City / State Charlottesville Va Zip Code 22903 -0000
E -mail ronals.cottrell @mjh.org Cellular #
Signature of Contractor or Authorized Agent Date
Primary Contact
Name Rummel, Klepper & Kahl LLP Phone #804) 782 -1903
Street Address 801 E Main Street Suite 1000 Fax #804) 782 -2142
City / State Richmond VA Zip Code 23219 -0000
E -mail mmills @rkkengineers.com Cellular #
Owner /Applicant
Name MJH FOUNDATION ATTN: OFFICE OF THE PRESIDENT Phone #434) 982 -7303
Street Address 459 LOCUST AVE Fax #434) 982 -7324
City / State CHARLOTTESVILLE VA Zip Code 22902-
E -mail ronald.cottrell @mjh.org Cellular #
Applicant
Name Martha Jefferson Health Services Corporation Phone # (434) 982 -7303
Street Address 459 Locust Ave Fax # (434) 982 -7324
City / State Charlottesville Va Zip Code 22903 -0000
E -mail ronals.cottrell @mjh.org Cellular #
Signature of Contractor or Authorized Agent Date
Application for Major & Minor Site Plan Amendments
an All Reinstatements J•
i -`
d of Denied or Deferred Site Plans
Major Amendment (Subject to Planning Commission Review) _ $270 Minor Amendment (alterations to parking, circulation,
1 JWded copies gf'plan are required building size, location) _ $95
Bolded copies o 'sketc•h plan are required
Reinstate Plan Review After 10 day Denial = $200 Reinstate Plan After Site Review Denial or Suspension = $65
Reinstate Plan Deferred by Applicant
To a specific date = S35
Indefinitely = S75
I 7 d copies O lan are required
Groundwater Assessment /Rcynirecl Jrn crl! nun- rrsidcnlrul.ciie plenl.c nut .cr, rircc! hi l,i,hlir trulr,l
Was a Groundwater Assessment conducted for the existing site plan?
VES
NO
If NO and the new plans show a use less than 2,000 gallons per dap Tier 3 Groundwater Review - $400
If NO and the new plans show a use greater than 2,000 gallons per day Tier 4 Groundwater Review = $1,000
If VES and the use goes from less than to more than 2,000 gallons per day Tier 4 - Tier 3 = $400
If VES and the use does not change from less than to more than 2,000 gallons per day No fee
Relief from conditions of approval from Planning Commission or landscape waiver by agent = $180
Extension of approval prior to expiration of an approved plan = $45
Rehearing of Site Development Plan by the Planning Commission or Board of Supervisors = $190
Appeal of Site Development Plan to the Board of Supervisors = $240
Project Name: JYl - j r l } • 1f'_ li ti ,I Y Fkc ;F 1 1: -___
Tax map and parcel: a °" ,1 \ Magisterial District: Zoning:
Physical Street Address (if assigned):
Location of property (landmarks, intersections, or other):
Contact Person (Who Should xce call \N rite concerning this project' ?):
Address . : City _ \f «i?C _ - State Zip
Daytime Phone ( fj _y1 Fax F -mail r tea tie -l0'_ cY 44 _Liti_ C s _.`41
Owner of Record t , ZJ F t . ` . r
f' }mac _ '1A _xr;.(0. 5 _ _1, -_1 4LL' 1 1C! ii
Address t ` ` \ City State ` _ Zip
Daytime Phone ( 1114 Fax # t : +— E-mail t° ` C'
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Applicant ( Who is the Contact person representing'):
Address c Cit ' r State Zi rYa1 } til C iii k- l P
Daytime Phone ( }) C1'L , . _C .J - Fax # ( - C ,:- / ` ._ E-mail _C C
FOR OFFICE USE NLl• SDP # lriU `r t' l `, 7 c ' f7 CFeeAmount3 - Date Paid i _' L -Bk ahn: ¢(,i; ; f E „ Jteccipt # (, 7 Ck # . By
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401 McIntire Road Charlottesville, VA 22902 Voice: (434) 296 -5832 Fax: (434) 972 -4126
11 1 07 Pace I of t
Intended use or justification wt request:
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Owner /Applicant Must Read and Sign
This site plan as submitted contains all of the information required by Section 32.5 (Preliminary Plan) or Section 32.6 (Final
Plan) of the Albemarle County Zoning Ordinance. I understand that plans which lack infonnation required by said sections
shall be deemed incomplete and shall be denied by the agent within ten (10) days of submittal as provided in Section 32.4.2.1
or Section 32.4.3.3 as the case may be.
For Final Plans Only: To the best of my knowledge, I have complied with Section 32.4.3.1 and obtained tentative approvalsforallaAeapeconditionsfromtheappropriateagencies.
igna o w r, ontract P chaser, Agent Date
Print Name Daytime phone number of Signatory
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